DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Fracture of sustentaculum tali (right type II talar neck fracture with associated subtalar dislocation).
2. Closed dislocation of tarsal bone, joint unspecified (right subtalar dislocation).
POSTOPERATIVE DIAGNOSES:
1. Fracture of sustentaculum tali (right type II talar neck fracture with associated subtalar dislocation).
2. Closed dislocation of tarsal bone, joint unspecified (right subtalar dislocation).
OPERATIONS PERFORMED:
1. Open treatment of talus fracture with or without internal or external fixation.
2. Open treatment of talotarsal joint dislocation with or without internal or external fixation.
SURGEON: John Doe, MD
ANESTHESIA: General via endotracheal tube.
ESTIMATED BLOOD LOSS: Less than 200 mL.
TOURNIQUET TIME: Approximately 70 minutes.
COMPLICATIONS: None.
INDICATIONS FOR OPERATION: This approximately (XX)-year-old female patient was driving a motor vehicle when she sustained the above-stated injury in a crash. The patient was evaluated at the trauma center. She was cleared for surgical intervention. Because of the fracture, dislocation of the talar neck, it was felt to be a surgical emergency. The risks, benefits, and alternatives of the procedure were discussed with the patient, the patient’s family, and informed consent was signed and obtained. The patient was taken to surgery.
DESCRIPTION OF OPERATION: The patient was taken to the operating room, and general anesthesia was induced via an endotracheal tube. The patient was given 1 g of IV cefazolin prior to initiation of the surgical procedure. The right lower extremity was prepped and draped in a sterile fashion. A thigh-high tourniquet was applied. The limb was elevated and exsanguinated with an Esmarch bandage. The tourniquet was elevated to 350 mmHg.
A provisional closed reduction of the subtalar joint was performed; however, it was reduced to a subluxation point. At that point, an open reduction of the dislocation and the fracture was performed. A standard extensile approach between the tibialis anterior and posterior tibial tendon was carried down through the skin and subcutaneous tissue over the medial border of the talus.
Dissection was taken down. Care was taken to avoid stripping off the insertion of the tibialis anterior tendon. The talar neck with some body fracture was demonstrated as well as the talonavicular joint. Lateral Bohler incision centered over the fourth ray was taken down through skin and subcutaneous tissue. The intermediate branch of the superficial peroneal nerve was identified and protected.
Retinaculum over the extensor tendon was opened. The extensor tendons retracted, including the peroneus tertius exposing the extensor digitorum brevis, which was elevated from proximal and distal thus exposing sinus tarsi to allow process with talus and accommodate the lateral talus body neck fracture to an open wound.
An open reduction of the subtalar joint was performed. The talar neck was then reduced by placing of Weber clamp in the distal head and neck segment to the medial and lateral wounds and reducing the fracture anatomically. Avulsive concomitant fracture of osteochondral fracture along the articular dome and head were revealed along the medial side. These osteochondral fractures that were so viable were placed back in the anatomic position.
Multiple 1.6 mm K-wires were used to provisionally stabilize the talus fracture. Reduction was confirmed on two plane image intensification, including lateral axial views as well as the Canale view demonstrating the reduction of the talar body and neck.
At that point, two 3.5 mm screws were placed, one placed lateral to posteromedial and a second screw was placed to the talar head from medial to posterolateral. Both screws were confirmed within body of talus and two plane image intensification demonstrated stabilization and neutralization across the fracture. With anatomic reduction stable, internal fixation of subtalar joint was anatomically reduced.
The wounds were copiously irrigated and closed in layers; the fascial layers with figure-of-eight 0 Vicryl suture, subcutaneous layer with inverted 2-0 Vicryl suture, and the skin with 3-0 nylon horizontal mattress suture. Sterile compressive dressings and a well-padded posterior splint were applied. The patient tolerated the procedure well and was taken to PACU in stable condition. There were no complications.
